PROCESS SAFETY Culture Enablers

S Bhasker Kumar 15th Dec 2014

Tata - Leadership with Trust

• Gross revenue > $103 Billion with 67% generated in geographies other than India

• Operations in more than 100 countries across six Continents,

• Total Number of Employees >580,000 • Conglomerate of over 100 companies in 7

Business Sectors: Materials Energy Chemicals Services Consumer Products IT & Communications Engineering Products & Services

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Tata Chemicals – Global Presence

TATA CHEMICALS NORTH AMERICA EPM POTASH MINES, USA

TATA CHEMICALS LIMITED RALLIS INDIA LIMITED

TATA CHEMICALS SOUTH AFRICA

IMACID, MORROCO

TATA CHEMICALS MAGADI, KENYA

TATA CHEMICALS EUROPE BRITISH

SALT, UK

JOIL, SINGAPORE

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Tata Chemicals- Mission, Vision & Values

Mission Serving Society through Science

Vision We shall be amongst premier chemical companies by: Leveraging Science to deliver new and innovative offerings Enhancing value to our customers Delivering Superior Returns to our shareholders Leading in corporate sustainability Nurturing innovation, learning through diversity and team work amongst employees

Values Integrity, Safety, Excellence, Care & Innovation

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DAP NPK

Salt & Soda Ash

Urea

Tata Chemicals Works in India

Site area : 1520 acres

Plants : Ammonia, Urea, O&U, Product Packaging

and Customized Fertilizers

Plant Capacities Ammonia 2000 MTPD Urea 3500 MTPD Customized Fert. 400 MTPD

Technology

Urea : Snamprogetti, Italy Ammonia : Haldor Topsoe, Denmark CF : A J Saket, USA

Tata Chemicals Ltd - Babrala Site

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Ammonia

Power & Steam

Prod Packaging Urea

De-mineralisation

NH3

CO2

Dispatch

NG/Naphtha

Urea

Bagged Urea

Ammonia storage

Cooling towers

Inert gas Instrument air Rail: 80%

Road: 20%

Urea Plant

Ammonia Plant

Urea Manufacturing Process

Air

Operational Excellence through Processes & People

Operational Excellence

Processes & Systems

People

• Strong Process & Systems orientation

• Focus on excellence

• Doing right for the first time • People the most valuable

assets • Focus on capability building • Open and equal opportunity

climate • Knowledge Management • Culture of learning & Sharing

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Process Improvement Techniques

Benchmarking

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F M E A

Manthan

R C A

C O Q

Tata Business Excellence Model

Integrated Management Systems (ISO 9001, ISO 14001, RC 14001 & OHSAS 18001)

Balanced Scorecard

Six-Sigma

7-QC tools

Suggestion Scheme

Process Framework

KM

BSC model – SHE Process Safety Management

Driving Excellence through Process Orientation

SPC

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2001-03 2004-06 2006-13

• BSC Model for SHE • Responsible Care • Adopting Best Practices • PSM & WSM •ISO 9001/ 14001

•OHSAS 18001

• RC-14001 • Six sigma • Benchmarking • Extension of OHS system to township • Corporate Sustainability • Behavior Based Safety

Our Journey – Safety Management Systems

2013-14 onwards

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In spite of running process safety programs in many facilities,

major process incidents continue to occur??

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The Key is

Process Safety Culture

Which is the Pillar

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Culture: Two aspects

• Something an organisation is: shared values and beliefs.

• Something an organisation has: structures, practices, systems.

• Changing practices easier than changing values and beliefs.

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The UK HSE defines safety culture as “ . . . the product of the individual and group values, attitudes, competencies and patterns of behavior that determine the commitment to the style and proficiency of an organization's health and safety programs.”

Process Safety Culture

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Process Safety Culture

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• ‘Safety culture’ is a subset of the overall company culture.

• ‘safety culture’ may be used to refer to the inclination of employees to comply with rules or act safely or unsafely

• However, culture and style of management is even much more deeper • e.g. a natural, unconscious bias for production over safety,

or a tendency to focussing on the short-term and being highly reactive, etc.

Process Safety Culture

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Types of Process Safety Culture

Organic

Proactive

Certificate

Reactive

Denial

Dynamically responding to risk. Quick to learn and improve

Learning from incidents Implement system on paper React after an incident What has not happened will never happen

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Some barriers to cultural progression

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PSM IS A MINDSET CHANGE

A SHIFT IN BELEIFS / CULTURE

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2 Actively Caring and the Safety Triangle

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Person Sharing skills and knowledge

with each other. Listening, helping

in a crisis, recognizing team member contributions.

Behavior Observing co-workers,

giving feedback, modeling behavior.

1 Environment Making sure needed equipment

is available. Posting warning signs,

housekeeping, cleaning other’s work

area.

Often neglected in traditional safety approaches. Little or no feedback on or encouragement of safe behavior.

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Actively Caring Increases Effectiveness

Please hold handrail when going up and down stairs

Caution! Stairs may be

wet. Please hold

handrail on stairs.

Set a safe example for others. Please hold handrail on

stairs

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Values, Intentions and Behaviors

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Perc

ent A

gree

men

t with

Sur

vey S

tate

men

t

Sho uld(Value)

Willing(Intentio ns )

Do(Behavio r)

Cautioning co-workers about performing unsafe acts

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Developing Safe Habits

Unconsciously Competent

Consciously Competent

Consciously Incompetent

Unconsciously Incompetent I didn’t know there was a better way

I know there’s a better way, I need to learn it.”

I know I am doing this right because I’m following the procedure

I no longer think about it; I know it is right and now it is a habit

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Process Safety Culture Enablers

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Top Management Involvement & Commitment

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Top Management Involvement & Commitment • Personal involvement of senior management • Process safety versus production, cost etc. • Must “Walk the Talk” and “Lead by Example” • Felt Leadership: demonstration of visible and credible

commitment – Appear regularly on the ‘shop floor’, talk about OHS and process

safety – visibly demonstrate their commitment by their actions – perceived as ‘sincerely committed to safety’

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Top Management Involvement & Commitment

Other examples of required leadership behaviours: • Maintaining a “Sense of Vulnerability” • Avoiding “Normalization of Deviation” • Receptiveness to bad news by top management • Ensuring process safety competency at decision making levels and

operating levels • Focus on measuring process safety performance rather than only

relying TRIR

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Accidents

Human Errors

Human Factors (weak management systems / culture)

Root Causes

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Top Management Involvement & Commitment

• Ensures Learning from Incident: Process incidents and near misses are reported and investigated to their root causes. – root causes mostly lie within organisational issues or human

factors (system & culture) – Human factors are not the same as human errors and are

organisational or technical factors which led people to make mistake

– Top management to avoid getting stuck up in the “Human errors” and focus on “Human factors”

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Steps for visible commitment & involvement by sr. management • Encourage visual displays and communication on 9 golden

safety rules • Senior management to visit plant at least once a week,

discuss one golden rule and relate with any job going on and share any related incident with plant operators and maintenance technicians.

• Head of departments to participate in morning meeting with technicians/maintenance contract workers at least twice a week and talk about safety

• During training class, site head to address the class at the beginning at least once a month

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Steps for visible commitment & involvement by sr. management - contd. • Improve effectiveness of consequence management system.

(display of cardinal rules, communication about the same, circulation of consequence matrix among HODs and adherence)

• During any major jobs, shutdown or turnaround, Sr. management must talk about safety first, during planning, before starting or during the job (more emphasis to be laid on safety)

• Personal involvement of Sr. Management in reporting near misses, process incidents, BBS observations

• Participate and encourage their dept colleagues also to participate in all SHE related meetings, activities and celebrations

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Steps for visible commitment & involvement by sr. management - contd. • Sr. Mgt (i.e HOD’s + Executives) should be role models in

their conduct with respect to safety procedures, use of PPEs, adherence to timings etc which slowly becomes a culture

• Need to spread / inculcate culture of “Duty of Care” which can have multiplying effect in building safety culture.

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Risk Based Decision Making for PSM

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Missing link in PSM implementation

Top Mgmt. Commitment

PSM

Risk Based Approach

Institutionalization of Risk Based Decision Making

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Risk Based Approach

• Focuses on operation and maintenance risk in the process

plant

• Risks are minimized As Low As Reasonably Practical (ALARP)

• Institutionalizes risk based decision making • Uniform understanding of whether risk are acceptable or not (organization

wide alignment in the perception and control of process risks)

• Communication of process risks to the appropriate levels

• Process safety is considered in a systematic way and does not get

overridden even during times of pressure

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As Low As Reasonably Practical (ALARP)

Unacceptable

Tolerable

Broadly Acceptable

Risk cannot be justified

only if further risk reduction not practical /

cost effective

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Operations & Maintenance Risk Matrix • Operations and maintenance risk matrix aligned with

overall risk management strategy of TCL has been developed

• The risk matrix is based on the As Low As Reasonably Practical (ALARP) philosophy.

• All decisions that could create process safety exceptions shall be taken through the operations and maintenance risk matrix to assess the risk level

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OPERATIONAL AND MAINTENANCE RISK MATRIX Frequent 1 in 2

years or less Probable 1 in 5

years HIGH Occasional 1 in 10

years MEDIUM Remote 1 in 20

years LOW Improbable 1 in 50

years

People

First aid case (FAC)

Medical treatment cases or Restricted work case (MTC or RWC)

Lost Work Day cases (LWC)

Single Fatality or Permanent disability

Multiple fatalities

Assets Slight damage

Minor damage

Local damage Major damage

Extensive damage

Environment Slight effect Minor effect Localised effect

Major effect Massive effect

Reputation Slight impact Minor impact Regional impact

National impact

World wide impact

IMPACT PRO

BA

BIL

ITY

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Process Safety Exception

Any management decision that does not align

with the major objective of Process Safety

Management (which is to prevent unwanted releases of

hazardous chemicals especially into locations that could

expose employees and others to serious hazards)

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Process Safety Exception Few examples: • Not releasing equipment for planned inspection schedule • Extending service of an equipment/pipeline etc already recommended by

inspection to be repaired/replaced • Postponing any Pre Startup Safety review (PSSR) recommendation but going

ahead with commissioning of the equipment • Extending process incident investigation recommendations implementation

dates. • Extending Process Hazard Analysis study recommendations implementation

dates. • Delaying planned plant turnaround • Any out of budget expenditure related to process safety that is not approved due

to budget constraints

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Using Operations & Maintenance Risk Matrix

• If the risk falls in High Risk category, the decision is not acceptable and continued operation of the plants is not allowed unless measures are implemented to lower the risk to medium category.

• If decision is taken to continue to operate in High Risk category, this decision must be officially communicated to and approved by Chief Operating Officer and Managing Director (Occupier of factory).

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Using Operations & Maintenance Risk Matrix

• If risk category is medium, additional controls (engineering or administrative) needs to be implemented and risk shall be communicated to and approved by VP- Manufacturing

• If risk category is low, no additional action is required

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Using Operations & Maintenance Risk Matrix

• Risks keep dynamically changing • All the decisions taken through the risk matrix need to be reviewed

weekly in the WPM. • All decisions taken through the Operation and Maintenance Risk

Matrix shall be recorded in PROCESS SAFETY EXCEPTION APPROVAL FORM

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Process Safety Competency and Knowledge Management

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Process Safety Competency and Knowledge Management

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Process Safety Competency

• Competencies required for process safety is a combination of technical and managerial skills.

Managerial Culture

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Engineering

Culture

Process Safety Competency

Some of the key process safety competencies are – understanding SOPs and maintenance procedures, – key process safety information like MSDS, P&IDs, PFDs, design

basis for emergency systems, etc – use of engineering codes and standards, – skills for finding root cause for process incidents, – HAZOP study – Process of Management of Changes, – Pre-Design Checklist for Management of Change, etc.

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Process Safety Competency Procedure • Position wise PSM training needs are identified

“Position wise Process Safety Competencies/Training Matrix” • PSM Training Calendar” –Yearly • Training & Re-training once every three years • Pool of trained people in HAZOP • Pool of trained people in Process Incident Investigation • Pre-Design Checklist • Training on the relevant engineering codes & standards – shall be

arranged annually by Head – TS & Projects • All Executives, HOD’s and Managers shall be trained annually on the

procedure for “Institutionalizing Risk Based approach towards process safety”

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Process Safety Knowledge Resources

BP Process Safety Series 1. Hazards of Water 2. Hazards of Air and Oxygen 3. Hazards of Steam 4. Hazards of Trapped Pressure and Vacuum 5. Confined Space Entry 6. Hazardous Substances in Refineries 7. Hazards of Electricity and Static Electricity 8. Hazards of Nitrogen and Catalyst Handling 9. Control of Work 10. Safe Ups and Downs for Process Units

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Process Safety Knowledge Resources

CSB Videos

AICHE : Safety in Ammonia Plants and

Related Facilities Symposium

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Other Process Safety KM resources 1. All incidents since commissioning have been captured and

uploaded on F drive. The reasons for the incidents are also recorded.

2. Past KM stories related to process incidents shall be retrieved from Knowledge Management portal and shared in weekly training classes

3. Database for RCA reports of Process Safety incidents and – one page summary – KM portal

4. Learning from other plants / industry

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Weekly Performance Review Meeting

Performance Review Structure – Safety First

Apex Quality Council Meeting

Business Council Meeting

Executive Committee Review Meeting

Monthly

Monthly

Weekly

Daily Operations Review Meeting Daily

Monthly

Safety takes priority over everything – efficiency, production and maintenance

THANKS

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Acknoledegements: Dupont Safety ppts Prism Consultants

Backup Slides

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9 Golden Safety Rules

1. Permit to Work 2. Working at Height 3. Energy Isolation 4. Confined Space Entry 5. Lifting Operations 6. Standard Operating Procedures & MOC 7. Vehicle Safety 8. Ground Disturbance 9. Storage of Hazardous Chemicals

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Explanation of terms PROBABILITY • Frequent : 1 in 2 years or less: Based on actual experience and plant incident database • Probable: One in 5 years Based on actual experience and plant incident database • Occasional: One in 10 years Based on actual experience and plant incident database • Remote: One in 20 years Has happened in industry rarely • Improbable: One in 50 years Not possible to happen in plant lifetime (not happened in other plants also) 56

Explanation of terms IMPACT People: • Multiple fatalities • Single fatality or Permanent disability • Lost Work Day cases (LWC) • Medical treatment cases or Restricted Work Case (MTC or RWC) • First aid case (FAC)

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Explanation of terms IMPACT Assets: • Extensive damage: Multiple equipment damaged (explosions etc) • Major damage: Single line equipment damage resulting in plant

stoppage or any other damage resulting in continued operation with reduced load

• Local damage: Stoppage of one section of plant • Minor damage: Plant operations managed with standby equipment • Slight damage: No effect on production/safety

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Explanation of terms IMPACT Environment: • Massive effect: Impacts outside factory area • Major effect: Impacts within factory area • Localised effect: Impacts within individual plant possible • Minor effect: Impacts within section of plant • Slight effect: Reversible

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Explanation of terms IMPACT Reputation: • Worldwide Impact: International media interest • National Impact: National Media interest • Regional: Regional Media interest • Minor impact: Possible change in employee perception of safety • Slight impact: No significant change

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